But another area of required competence has come to the fore in recent years, which is the explosion of machine learning and artificial/augmented intelligence in medicine. While the impact of these in real-world clinical practice is still small, the long-term effect is likely to be substantial. Certainly clinicians should be familiar with the myriad of issues related to algorithms and models, including ethical concerns.
In the process of updating our chapter for the forthcoming 2nd edition of the textbook, Health Systems Science [2], my co-author Dr. Jesse Ehrenfeld and I took the opportunity to make this revision to the competencies by adding a 14th one:
14. Apply machine learning applications in clinical care
a. Discuss the applications of artificial/augmented intelligence in clinical settings
b. Describe the limitations and potential biases of data and algorithms
As with the original competencies, we encourage others to improve upon them. But it is also important to add this critical new one to the full set, which are listed below.
References
1. Hersh, WR, Gorman, PN, et al. (2014). Beyond information retrieval and EHR use: competencies in clinical informatics for medical education. Advances in Medical Education and Practice. 5: 205-212. https://www.dovepress.com/beyond-information-retrieval-and-electronic-health-record-use-competen-peer-reviewed-article-AMEP.
2. Skochelak, SE, Hawkins, RE, et al., Eds. (2017). Health Systems Science. New York, NY, Elsevier.
Appendix - Competencies in Clinical Informatics for Medical Education, circa 2020
1. Find, search, and apply knowledge-based information to patient care and other clinical tasks
a. Information retrieval/search - choose correct sources for specific task, search using advanced features, apply results
b. Evaluate information resources (literature, databases, etc.) for their quality, funding sources, biases
c. Identify tools to assess patient safety (e.g., medication interactions)
d. Utilize knowledge-based tools to answer clinical questions at the point of care (e.g., text resources, calculators)
e. Formulate an answerable clinical question
f. Determine the costs/charges of medications and tests
g. Identify deviations from normal (labs/x-rays/results) and develop a list of causes of the deviation
2. Effectively read from, and write to, the electronic health record for patient care and other clinical activities
a. Graph, display, and trend vital signs and lab values over time
b. Adopt a uniform method of reviewing a patient record
c. Create and maintain an accurate problem list
d. Recognize medical safety issues related to poor chart maintenance
e. Identify a normal range of results for a specific patient
f. Access and compare radiographs over time
g. Identify inaccuracies in the problem list/history/med list/allergies
h. Create useable notes
i. Write orders and prescriptions
j. List common errors with data entry (drop down lists, copy and paste, etc.)
3. Use and guide implementation of clinical decision support (CDS)
a. Recognize different types of CDS
b. Be able to use different types of CDS
c. Work with clinical and informatics colleagues to guide clinical decision support use in clinical settings
4. Provide care using population health management approaches
a. Utilize patient record (data collection and data entry) to assist with disease management
b. Create reports for populations in different healthcare delivery systems
c. Use and apply data in accountable care, care coordination, and the primary care medical home settings
5. Protect patient privacy and security
a. Use security features of information systems
b. Adhere to HIPAA privacy and security regulation
c. Describe and manage ethical issues in privacy and security
6. Use information technology to improve patient safety
a. Perform a root-cause analysis to uncover patient safety problems
b. Familiarity with safety issues
c. Use resources to solve safety issues
7. Engage in quality measurement selection and improvement
a. Recognize the types and limitations of different types of quality measures
b. Determine the pros and cons of a quality measure, how to measure it, and how to use it to change care
8. Use health information exchange (HIE) to identify and access patient information across clinical settings
a. Recognize issues of dispersed patient information across clinical locations
b. Participate in the use of HIE to improve clinical care
9. Engage patients to improve their health and care delivery though personal health records and patient portals
a. Instruct patients in proper use of a personal health record (PHR)
b. Write an e-message to a patient using a patient portal
c. Demonstrate appropriate written communication with all members of the healthcare team
d. Integrate technology into patient education (e.g., decision making tools, diagrams, patient education)
e. Educate patients to discern quality of online medical resources (Web sites, apps, patient support groups, social media, etc.)
f. Maintain patient engagement while using an EHR (eye contact, body language, etc.)
10. Maintain professionalism through use of information technology tools
a. Describe and manage ethics of media use (cloud storage issues, texting, cell phones, social media professionalism)
11. Provide clinical care via telemedicine and refer patients as indicated
a. Be able to function clinically in telemedicine/telehealth environments
12. Apply personalized/precision medicine
a. Recognize growing role of genomics and personalized medicine in care
b. Identify resources enabling access to actionable information related to precision medicine
13. Participate in practice-based clinical and translational research
a. Use EHR alerts and other tools to identify patients and populations eligible for participation in clinical trials
b. Participate in practice-based research to advance medical knowledge
14. Apply machine learning applications in clinical care
a. Discuss the applications of artificial/augmented intelligence in clinical settings
b. Describe the limitations and potential biases of data and algorithms
a. Information retrieval/search - choose correct sources for specific task, search using advanced features, apply results
b. Evaluate information resources (literature, databases, etc.) for their quality, funding sources, biases
c. Identify tools to assess patient safety (e.g., medication interactions)
d. Utilize knowledge-based tools to answer clinical questions at the point of care (e.g., text resources, calculators)
e. Formulate an answerable clinical question
f. Determine the costs/charges of medications and tests
g. Identify deviations from normal (labs/x-rays/results) and develop a list of causes of the deviation
2. Effectively read from, and write to, the electronic health record for patient care and other clinical activities
a. Graph, display, and trend vital signs and lab values over time
b. Adopt a uniform method of reviewing a patient record
c. Create and maintain an accurate problem list
d. Recognize medical safety issues related to poor chart maintenance
e. Identify a normal range of results for a specific patient
f. Access and compare radiographs over time
g. Identify inaccuracies in the problem list/history/med list/allergies
h. Create useable notes
i. Write orders and prescriptions
j. List common errors with data entry (drop down lists, copy and paste, etc.)
3. Use and guide implementation of clinical decision support (CDS)
a. Recognize different types of CDS
b. Be able to use different types of CDS
c. Work with clinical and informatics colleagues to guide clinical decision support use in clinical settings
4. Provide care using population health management approaches
a. Utilize patient record (data collection and data entry) to assist with disease management
b. Create reports for populations in different healthcare delivery systems
c. Use and apply data in accountable care, care coordination, and the primary care medical home settings
5. Protect patient privacy and security
a. Use security features of information systems
b. Adhere to HIPAA privacy and security regulation
c. Describe and manage ethical issues in privacy and security
6. Use information technology to improve patient safety
a. Perform a root-cause analysis to uncover patient safety problems
b. Familiarity with safety issues
c. Use resources to solve safety issues
7. Engage in quality measurement selection and improvement
a. Recognize the types and limitations of different types of quality measures
b. Determine the pros and cons of a quality measure, how to measure it, and how to use it to change care
8. Use health information exchange (HIE) to identify and access patient information across clinical settings
a. Recognize issues of dispersed patient information across clinical locations
b. Participate in the use of HIE to improve clinical care
9. Engage patients to improve their health and care delivery though personal health records and patient portals
a. Instruct patients in proper use of a personal health record (PHR)
b. Write an e-message to a patient using a patient portal
c. Demonstrate appropriate written communication with all members of the healthcare team
d. Integrate technology into patient education (e.g., decision making tools, diagrams, patient education)
e. Educate patients to discern quality of online medical resources (Web sites, apps, patient support groups, social media, etc.)
f. Maintain patient engagement while using an EHR (eye contact, body language, etc.)
10. Maintain professionalism through use of information technology tools
a. Describe and manage ethics of media use (cloud storage issues, texting, cell phones, social media professionalism)
11. Provide clinical care via telemedicine and refer patients as indicated
a. Be able to function clinically in telemedicine/telehealth environments
12. Apply personalized/precision medicine
a. Recognize growing role of genomics and personalized medicine in care
b. Identify resources enabling access to actionable information related to precision medicine
13. Participate in practice-based clinical and translational research
a. Use EHR alerts and other tools to identify patients and populations eligible for participation in clinical trials
b. Participate in practice-based research to advance medical knowledge
14. Apply machine learning applications in clinical care
a. Discuss the applications of artificial/augmented intelligence in clinical settings
b. Describe the limitations and potential biases of data and algorithms
